Spiralling into the nephrotic syndrome

A 35-year-old white woman presented to a peripheral hospital emergency department 18 days after giving birth to her second child at 33 weeks and 3 days of gestation. She had significant weight gain and increasing peripheral oedema that had started 12 days after the birth. She had no history of breathlessness, rash, ulcers, photosensitivity, arthralgia, recent travel, use of non-steroidal anti-inflammatory drugs or use of recreational drugs. Both of her pregnancies had been complicated by hypertension, without proteinuria, and gestational diabetes, which had resolved spontaneously after each birth. Results of tests performed during the second trimester of her second pregnancy are shown in Box 1. Her past medical history included Raynaud phenomenon and adult attention deficit disorder, which was well controlled with dexamphetamine. She was a non-smoker and non-drinker and in a stable long-term relationship. She was referred by the peripheral hospital to the renal clinic of a large metropolitan hospital with suspected nephrotic syndrome.

The patient was reviewed in the renal clinic 21 days after the birth. On physical examination, her weight was 73 kg and both of her legs had marked pitting oedema. No rashes, lymphadenopathy or joint swelling were evident. Tests confirmed the nephrotic syndrome with a serum albumin level of 22 g/L (reference interval [RI],…